Rate of Kids Without Health Insurance Decreased Nationwide and in 21 States in 2021, Inequities Persist

Posted September 27, 2022, By the Annie E. Casey Foundation

Update healthinsurance 2022

Accord­ing to the U.S. Cen­sus Bureau’s new Amer­i­can Com­mu­ni­ty Sur­vey data on the KIDS COUNT Data Cen­ter, the rate of chil­dren under age 19 with­out health insur­ance dropped to 5% in 2021. That’s an esti­mat­ed 4,165,000 mil­lion kids nation­wide — down from 6% in 2019. Twen­ty-one states also saw declines.

Since the COVID-19 pan­dem­ic hit, Con­gress has passed mul­ti­ple relief mea­sures that bol­stered the insur­ance safe­ty net for chil­dren and fam­i­lies, including:

  • increased state fund­ing to ensure that Med­ic­aid enrollees did not lose cov­er­age dur­ing the pandemic;
  • reduced costs for pur­chas­ing cov­er­age through the Afford­able Care Act (ACA) health insur­ance mar­ket­place; and
  • expand­ed fed­er­al and state mea­sures, such as the Children’s Health Insur­ance Pro­gram (CHIP), to improve access to insurance.

What Are Med­ic­aid and CHIP?

Cen­sus Bureau analy­sis indi­cates that increased enroll­ment in Med­ic­aid and CHIP was behind the reduced U.S. rate of unin­sured chil­dren in 2021, but what do these pro­grams entail?

  • Med­ic­aid is a large pub­lic health insur­ance pro­gram for chil­dren and adults who meet a low-income eli­gi­bil­i­ty thresh­old. Under the ACA, states can expand Med­ic­aid eli­gi­bil­i­ty to more low-income fam­i­lies. In 2021, 36 states and Wash­ing­ton, D.C. had expand­ed their Med­ic­aid eli­gi­bil­i­ty require­ments.
  • CHIP is anoth­er pub­lic insur­ance pro­gram for chil­dren in fam­i­lies whose incomes are too high to qual­i­fy for Med­ic­aid but like­ly too low to afford pri­vate insurance.
  • While kids and young adults can be cov­ered under a parent’s or guardian’s insur­ance plan up to age 26, only chil­dren under age 19 can qual­i­fy for Med­ic­aid or CHIP.

One-in-Three Chil­dren Rely on Pub­lic Insurance

Nation­wide, about one-third of kids (34%) received pub­lic health insur­ance in 2021, while near­ly half (48%) were cov­ered through employ­er-based insur­ance. Far few­er chil­dren had oth­er types of cov­er­age, includ­ing a mix­ture of pub­lic and pri­vate insur­ance (5%), a plan pur­chased direct­ly from an insur­ance com­pa­ny (5%) or oth­er pri­vate insur­ance (2%).

At the state lev­el, the share of kids with pub­lic insur­ance ranged from 13% in Utah to more than half (51%) in New Mex­i­co in 2021.

Why Insur­ing Chil­dren Matters

Kids with insur­ance are more like­ly to access time­ly med­ical care for health needs. They have improved phys­i­cal, men­tal and behav­ioral health out­comes com­pared to those with­out cov­er­age. Poor health dur­ing child­hood can affect vir­tu­al­ly every area of a child’s life, includ­ing school per­for­mance, and can have last­ing con­se­quences on health, well-being and finan­cial secu­ri­ty into adulthood.

Chil­dren eli­gi­ble for pub­lic insur­ance are espe­cial­ly like­ly to see the ben­e­fits of health cov­er­age, includ­ing increased eco­nom­ic sta­bil­i­ty for their fam­i­lies. For instance, when a fam­i­ly receives Med­ic­aid, they can use more of their income on oth­er basic needs like food and hous­ing. Med­ic­aid has also been linked to reduced med­ical debt and bank­rupt­cies, and it is con­sid­ered one of the nation’s lead­ing anti-pover­ty programs.

Insur­ing par­ents helps chil­dren, too. It increas­es the like­li­hood of parental health and strength­ens par­ents’ abil­i­ty to care for their children.

Children’s Risk of Being Unin­sured Varies by State

Many fac­tors, such as state poli­cies and prac­tices and local eco­nom­ic con­di­tions, influ­ence the wide vari­a­tion in access to cov­er­age across the coun­try. In 2021, the low­est unin­sured rates for chil­dren were in the North­east states of Mass­a­chu­setts (1%), Ver­mont (2%) and Con­necti­cut (2%). The high­est rate was in Texas, with 12% — or 930,000 kids — lack­ing insurance.

How­ev­er, Texas was among the 21 states that improved in 2021, with its rate of unin­sured chil­dren declin­ing by one per­cent­age point, from 13% in 2019. The oth­er 20 states that made gains in 2021 also saw declines of one to two per­cent­age points. Despite this progress, rates of unin­sured chil­dren increased in sev­en states and Wash­ing­ton, D.C. in 2021, each by one or two per­cent­age points as well.

Inequities Per­sist, Par­tic­u­lar­ly for Amer­i­can Indi­an Children

The rate of unin­sured Amer­i­can Indi­an chil­dren has been more than twice the nation­al rate in all four years of data avail­able on the KIDS COUNT Data Cen­ter, although the per­cent­age for Amer­i­can Indi­an chil­dren fell in 2021, from 14% in 2019 to 12%. The unin­sured rate for Lati­no chil­dren (9% in 2021) has also remained high­er than the nation­al lev­el for four years. Among kids of two or more races, the rate increased from 4% in 2019 to 6% in 2021. Fig­ures have been fair­ly steady for Black (5% in 2021), white (4%) and Asian and Pacif­ic Islander (4%) children.

In addi­tion, immi­grant chil­dren, par­tic­u­lar­ly those who are undoc­u­ment­ed, are at increased risk of being unin­sured com­pared to their peers with U.S. citizenship.

Address­ing Inequities and Bar­ri­ers to Health Insurance

Although pan­dem­ic-era poli­cies helped many chil­dren and fam­i­lies access and keep cov­er­age dur­ing this nation­al health cri­sis, approx­i­mate­ly 4 mil­lion kids still lack health insur­ance, and con­cern­ing dis­par­i­ties in access to cov­er­age remain. Con­cert­ed action is also need­ed just to main­tain the gains of 2021, as the fed­er­al man­date for states to ensure con­tin­u­ous Med­ic­aid cov­er­age is slat­ed to end when the pan­dem­ic is over. States, too, can take action to keep eli­gi­ble fam­i­lies enrolled in Med­ic­aid or help them enroll in oth­er plans.

Pol­i­cy­mak­ers and lead­ers in mul­ti­ple sec­tors must con­tin­ue work­ing toward sys­temic change to address the long-stand­ing inequities and bar­ri­ers that con­tribute to the dis­pro­por­tion­ate­ly high unin­sured rates among Amer­i­can Indi­an chil­dren. Addi­tion­al­ly, lead­ers can reduce immi­gra­tion-relat­ed bar­ri­ers to enroll­ment in Med­ic­aid and the ACA health insur­ance marketplace.

More Child and Fam­i­ly Health Resources

See all health insur­ance data on the KIDS COUNT Data Cen­ter, includ­ing these new­ly updat­ed indicators:

Addi­tion­al resources:

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